Tremors And Tics in Children

Question of the Week

A parent and child waiting for their pediatrician.
A visit to your pediatrician would be a good idea if your child has a tremor.. Photo by Getty Images

Question. My two-year-old daughter's hands occasionally shake. It is mainly when she is carrying something kind of heavy or when she is concentrating or excited. Could this be an indication of any sort of health problems? Joanna

Answer. It could be a sign of a tremor, which if she is otherwise healthy and growing and developing normally, is not necessarily a sign of any kind of serious disorder.

Children with Tremors

In fact, there is a condition called familial tremor, in which involuntary shaking runs in the family.

Children can also have an essential tremor or shakes for which the cause is unknown.

How common are essential tremors in kids?

It is thought that up to 5% of people have an essential tremor and one study found that essential tremors commonly started as early as age eight years.

Having a tremor can also be a side effect of some medications and certain metabolic disorders, like hyperthyroidism and hypoglycemia. In general, you would usually expect your child to also have other symptoms if a specific medical problem was causing her hands to shake.

Children with Tics and Twitches

In addition to tremors, children can commonly have tics.

Although many parents have a first thought that their child must have Tourette syndrome or another condition if their child has a tic, it is much more common to have a simple transient tic disorder.

Children with a transient tic disorder typically:

  • make sudden, brief jerky movements of their arms
  • blink their eyes repeatedly
  • raise their eyebrows
  • shrug their shoulders
  • bite their lip
  • turn their head

In addition to these types of involuntary motor tics, other children may clear their throat or make specific sounds (vocal tics). These tics are often so subtle that other people don't notice them, although parents typically do as they see them so often.

As the name suggests, transient tics only last a short time, typically less than about three months.

If tics are lasting much longer or they are becoming more complex, an evaluation for Tourette syndrome might be a good idea.

Be aware that tics and OCD symptoms that start suddenly or worsen have a strep throat infection could be a sign of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)

Treating Tremors and Tics

A visit to your pediatrician would be a good idea to get a child with tics or tremors further evaluated.

Most importantly, that will help you figure out if what she is doing is really even a tic or tremor. And then a physical examination, including a complete neurological exam, can help to figure out what is causing it.

A Pediatric Neurologist can also be helpful if she is really having tremors or persistent tics, although children with transient tics and essential and familial tremors often don't need any kind of treatment.

Tremors can sometimes be treated with beta blockers if they do cause a problem later on, like if it causes difficulty writing because her hands shake too much.

Sources:

Jankovic, Joseph MD;Essential Tremor Among Children. PEDIATRICS Vol. 114 No. 5 November 2004

Knight, Thomas. Prevalence of Tic Disorders: A Systematic Review and Meta-Analysis. Pediatric Neurology. August 2012Volume 47, Issue 2, Pages 77–90

Swain, James E. Tourette Syndrome, and Tic Disorders: A Decade of Progress. Journal of the American Academy of Child and Adolescent Psychiatry. August 2007Volume 46, Issue 8, Pages 947–968.

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